Document Type

Journal Article

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Publication Source

International Journal of Nursing Studies





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Although self-care may reduce exacerbations of heart failure, reported rates of effective self-care in patients with heart failure are low. Modifiable factors, including psychosocial status, knowledge, and physical factors, are thought to influence heart failure self-care, but little is known about their combined impact on self-care.


The objective of this study was to identify factors related to self-care behaviors in patients with heart failure.


A cross-sectional, correlational study design was used.

Participants and settings

One hundred twenty-two patients (77 men and 45 women, mean age 60 ± 12 years old, 66% New York Heart Association functional class III/IV) were recruited from the outpatient clinics of an academic medical center and two community hospitals.


Data on self-care behaviors (Self-Care of Heart Failure Index), depressive symptoms, perceived control, self-care confidence, knowledge, functional status, and social support were collected. Factors related to self-care were examined using hierarchical multiple regression.


Mean self-care behavior scores were less than 70 indicating the majority of men and women with HF did not consistently engage in self-care behaviors. Higher self-care confidence and perceived control and better heart failure management knowledge were associated with better self-care (r2 = .25, p < .001). Higher perceived control and better knowledge were related to better self-care behaviors in men (r2 = .18, p = .001), while higher self-care confidence and poorer functional status were related to better self-care behaviors in women (r2 = .35, p < .001).


This study demonstrates the substantial impact of modifiable factors such as confidence in one’s self-care abilities, perceived control, and knowledge on self-care behaviors. This study demonstrates that there are gender differences in factors affecting self-care, even though at baseline men and women have similar knowledge levels, physical, psychological, and behavioral status. Effective interventions focusing on modifiable factors and the unique characteristics of men and women should be provided to improve self-care behaviors in patients with heart failure.

Copyright/Permission Statement

NOTICE: This is the author’s version of a work that was accepted for publication in International Journal of Nursing Studies. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Nursing Studies, 2008, 45(12), 1807-1815, doi: 10.1016/j.ijnurstu.2008.05.008.


gender, heart failure, self-care



Date Posted: 01 June 2016

This document has been peer reviewed.